Effecting Change Based on What Program Directors Think

Regarding the international medical graduates (IMG) applying to radiology, our survey results are in line with the National Resident Matching Program (NRMP) data ( 1 http://www.nrmp.org/match-data/main-residency-match-data/ Google Scholar ), which show that US medical school graduates have an overall match rate almost double that of IMG applicants. At the same time, the recent literature ( 2 Boulet J.R. Swanson D.B. Cooper R.A. et al. A comparison of the characteristics and examination performances of U.S. and non-U.S. citizen international medical graduates who sought Educational Commission for Foreign Medical Graduates certification: 1995–2004. Acad Med. 2006; 81: S116-S119 Crossref Google Scholar , 3 Benson J.A. Meskauskas J.A. Grosso L.J. Performance of U.S. citizen foreign medical graduates on certifying examinations in internal medicine. Am J Med. 1981; 71: 270-273 Abstract Full Text PDF PubMed Scopus (21) Google Scholar , 4 Shea J.A. Norcini J.J. Day S.C. et al. Performance of U. S. citizen Caribbean medical school graduates on the American Board of Internal Medicine certifying examinations, 1984–1987. Teach Learn Med. 1989; 1: 10-15 Crossref Scopus (9) Google Scholar , 5 Norcini J.J. Anderson M.B. McKinley D.W. The medical education of United States citizens who train abroad. Surgery. 2006; 140: 338-346 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar , 6 Norcini J.J. Boulet J.R. Dauphinee W.D. et al. Evaluation of quality of care provided by graduates of international medical schools. Health Aff. 2010; 29: 1461-1468 Crossref PubMed Scopus (106) Google Scholar , 7 Garibaldi R.A. Subhiyah R. Moore M.E. et al. The In-Training Examination in Internal Medicine: an analysis of resident performance over time. Ann Intern Med. 2002; 137: 505-510 Crossref PubMed Scopus (81) Google Scholar , 8 Gozu A. Kern D.E. Wright S.M. Similarities and differences between international medical graduates and U.S. medical graduates at six Maryland community-based internal medicine residency training programs. Acad Med. 2009; 84: 385-390 Crossref PubMed Scopus (28) Google Scholar ) does not offer a clear justification for such pronounced preference on the basis of clinical or academic performance. Dr. Pfeifer offers his personal experience in support of IMG radiology trainees and states that the literature quoted in our article cannot be easily extrapolated to radiology. As a spoiler alert, the recently concluded 2016 Spring Association of Program Directors in Radiology survey shows ( 9 Annual Survey Committee of the APDR Personal communications. Results of the Spring 2016 membership survey. 2016 Google Scholar ) that among program directors, who have experience training IMG residents, 78% thought that IMGs performed as well as US medical doctors (MD) at the end of training. We agree with Dr. Pfeifer that more research is needed to understand the differences in performance, if any, among different trainee cohorts and the barriers to recruitment and training of IMG residents.